Sunday, March 28, 2010



Friday, March 26, 2010

Shoulder Separation

A shoulder separation is an injury to ligaments the AC joint, not the should joint. AC is the acromio-clavicular joint. The acromion is part of the scapula (shoulder blade) and the clavicle is the long narrow bone that comes across the should and attaches to your sternum.

A separation of this joint comes from a blunt force and not a twisting force like you would see in the knee or ankle. Falling, being hit in a contact sport, and car accidents are all prime candidate for AC separation injuries.

Like all ligament injuries, an AC separation comes in different severities. Listed below are the different grades of severity.

Type I Shoulder Separation:
This is the least severe. In a type 1 injury there is minor disruption to the capsule that surrounds the AC joint. Minor swelling and pain are the only symptoms. X-rays will look normal. There is no ligament damage in a type 1

Type II Shoulder Separation: The second level of injury is where the capsule and some damage to the coracoclavicular ligament. A small displacement in the clavicle can be seen. Pain and swelling are still minor.

Type III Shoulder Separation: A type three is nothing more than a more exacerbated version of a type two. The pain and swelling increase and the displacement near the AC joint is more pronounced

Type IV Shlder Separation: This type is when the clavicle is pushed inward and ends up behind the acromion. This is a rare injury.

Type V Shoulder Separation: This is an exaggerated version of a type three. The clavicle is dislodged and damages muscle tissue in the surrounding area. A prominent bump can be seen.

Type VI Shoulder Separation: This is the most rare version. The clavicle is pushed downward and moves into the coracoid process which is a part of the scapula (shoulder blade).

Treatment for AC separation includes icing the joint and taking non-steroidal anti-inflammatory drugs such as Advil, Ibuprofen, Motrin, and Excedrin. Tylenol and Aspirin are not anti inflammatory's. Type's IV through VI will likely require surgery to repair. Fortunately these are extremely rare and require tremendous force to occur.

Therapy can help speed up the recovery process. As the joint heals you will notice the lack of range of motion (ROM) in the should. Passive and active ROM exercises will be required to achieve full functionality. Never move the arm to position that gives you pain.

Sprained Ankle

Injuring an ankle can be quite debilitating. Let us look at what is going on anatomically and then look at reducing healing time.

The most common ankle injuries are sprains and strains. Strains occur to muscle and sprains occur to ligaments. Sprains are much more common, so I will focus on them for this article. They occur when there is stretching or tearing of a ligament.

Some terminology;
Ligament --> fibrous tissue that connects bone to bone. (not to be confused with tendon)
Sprain --> stretching or tearing of a ligament

Inversion Ankle Sprain
There are two types of ankle sprains. The one that is far more common is called an inversion sprain. An inversion sprain is when the foot is turned inward spraining the ligaments on the outside of the ankle. The anterior talofibular ligament is most affect. Look at the photo above and examine the position of the this ligament. It should be clear as to why it is so easily stretched.

Eversion Ankle Sprain
The second type of ankle sprain is an eversion sprain. An eversion sprain is when the foot is turn outward or away from the mid-line of the body. There is a strong ligament found on the medial side of the foot and is much tougher to stretch. This ligament is named the deltoid ligaments because is is triangular in shape. Fortunately, this type of injury is very rare because of the toughness of these ligaments. Unfortunately, an eversion sprain often times comes with a broken bone in the foot.

More terminology;
inversion sprain --> foot is turned inward toward mid line of body stretching or tearing
lateral ligaments (lateral means away from mid-line).
eversion sprain --> foot is turned outward or lateral to the mid-line of the body stretching or
tearing medial ligaments

High Ankle Sprain
There is a third type of ankle sprain that occurs less frequently than the other two. The sprain happens to the syndesmotic ligament. This ligament attaches the fibula to the tibia.

Symptoms of a sprain
  • mild to severe pain (pain may go away prior to an significant healing)
  • Little to gross joint instability
  • Little to gross swelling around the ankle joint
  • 0 to extensive bruising that will generally settle on the outside of the bottom of the foot.
Severity of a sprain
Sprains come in three grades. Grade 1, grade 2, and grade 3. Grade 1 is the least severe. You will have mild pain, little instability in the joint, and little swelling. Walking remains relatively unaffected, but running is encumbered by the mild instability and joint stiffness that is the result of swelling. Structural damage is limited to mild stretching of the affected ligament.

Grade 2 sprains are a little more severe. There is generally more pain, more significant swelling, more joint instability and some mild bruising. This severity of this type of sprain sees significant stretching and/or minor tearing of the ligament involved.

Grade 3 is the most severe and can involve complete tearing of the ligament involved. All of the symptoms listed above occur and the upper echelon you their severity. Bruising is severe. Swelling can encompass all the joint and much of the foot. The joint instability is so gross that walking is virtually impossible.

Treatment for a sprain is simple, as long as it is not too severe. If a sprain occurs simple remember the acronym R-I-C-E. R stands for rest. I stands for ice. C stands for compression. E stands for elevation. You'll want to protect the ankle immediately by not walking on it or putting any type of pressure on the joint. This can make the injury worse. Resting simply means do not attempt any of the strenuous activity that caused the injury in the first place. Keep pressure off of the joint by using a crutch. Use ice to reduce the swelling. Do not ice for more than 20 minutes at a time. If you ice a few times a day you should be okay. Use an ace bandage to compress the joint. The bandage should be tight, but not so tight as to cut of circulation. Compression also helps with swelling. Elevation minimizes swelling. If elevated, leave the ace bandage off. If you suspect a tear or complete tear consult a physician. Ligaments do not heal well nor can they reattach themselves.

A sprained ligament will heal on its own as long as there is not much tearing involved. Ligaments, however, do not have their own blood supply to bring them nutrients. The small arterioles that do reach the joint are usually sheared during the incident that causes the injury. The ligament will thus heal very slowly.

You will cease the R-I-C-E treatment after approximately three days (or longer for more severe sprains). The next step to your recovery is going to be restoring range of motion (ROM). Healing will cause the ligament to be stiff and inflexible. Passive and active motion exercises will be used. Passive exercises can be done by using your hands to stretch the joint. Stretch in all directions, but do not stretch to the point where you feel pain.

For active motion exercises use your muscles to flex the joint in all directions. Do not flex to the point where you feel pain. Keep doing these exercises and eventually you will find that you will be able to stretch further and further without feeling pain.

Continually use Non-steroidal anti-inflammatory drugs to help reduce selling and pain through the recovery period. Alieve, Ibuprofen, and Advil can all be used. Tylenol or Acetaminophen, or Aspirin are not NSAID's.

Please allow proper time to a sprain to heal. Additional sprains are much more likely when you have an unhealed sprain. It may take up to 6 months for a complete recovery of a grade 2 sprain. Increase activity gradually and always be cautious.

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